Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.

Venous thrombosis is a very rare occurrence in patients with hemophilia A. We present a one year old child with severe hemophilia A, who developed deep vein thrombosis in antecubital fossa following venous obstruction due to bleeding around the vein. We didn't start anticoagulant therapy to our patient because of the risk of further bleeding into subdural hemorrhage he had already developed. We could manage the thrombosis and save the limb by relieving the obstruction with replacement of factor VIII.

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The main problem of chronic pancreatitis is managing the chronic pain. When pharmacological means fail, ablative procedures like coeliac plexus ablation or bilateral splanchnicectomy becomes necessary. These procedures are designed based on anatomy. Pancreatic duct and common bile duct obstruction are known complications of chronic pancreatitis and methods of treatment are essentially based on interpretation of images. We present a case history of a patient with chronic pancreatitis who underwent bilateral thoracoscopic splanchnicectomy and later laparoscopic cholecysto-jejunostomy for common bile duct obstruction.The importance of anatomy in diagnosis and treatment are highlighted.Anniestan A , Jayathilaka AB , Galketiya KB